Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Park Nicollet Clinic

Organization Family Medicine Physician · NPI 1063897593

Park Nicollet Clinic is a Family Medicine Physician in St Louis Park, Minnesota. Registered with an NPI since 2015.

In the registry since
2015
Specialties on file
3

Practice location Address checks out

3800 Park Nicollet Blvd
St Louis Park, MN 55416-2527
Phone: (952) 993-3123
Fax: (952) 993-2770
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Family Medicine Physician (primary) Taxonomy 207Q00000X
Obstetrics & Gynecology Physician Taxonomy 207V00000X
Pediatrics Physician Taxonomy 208000000X

Record details

NPI number1063897593
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Alita Risinger — Sr Vice President, Cfo · (952) 883-5401
Other names Park Nicollet Clinic Episodic Bundle; Park Nicollet Clinic Episodic Bundle
NPI enumeratedJuly 27, 2015
Last updated in NPPESAugust 3, 2026
Certification dateAugust 3, 2026
Mailing address3800 Park Nicollet Blvd, Attention: Business Services, St Louis Park, MN 55416-2527

Other providers in St Louis Park